The success of familial compliance with a dietary manipulation programme was studied prospectively in 91 newborn babies from atopic families for up to 12 months. The control group consisted of 72 infants from non-atopic families. The percentages of infants breast-fed at the age of six months were 58% and 38% in the study group and control group, respectively. The introduction of cow's milk based formulas was postponed until the age of three months in 63% of the infants in the study group and 47% of the infants in the control group. Solid food was avoided during the first three months in 76% and 45% of the infants in the study group and control group, respectively. Maternal age, smoking and low social class were associated with poor compliance. The existence of atopic dermatitis in any member of the family was associated with good compliance. The main advantages of our programme were the increased number of children breast-fed until the age of six months, and the reduced number of infants introduced to cow's milk based formulas or solid food before three months of age.
"This study is the ®rst report to explore the causal relationship between predictors and adherence to treatment advice in AD. Only a few previous studies have referred to compliance matters in the treatment of AD (Poysa et al, 1988; Witkowski, 1988; Katzenberg and Hollander, 1989; Broberg et al, 1990; LoPresti, 1992; Fischer, 1996). We suppose one of the reasons for this is that there are no established and universally agreed treatment protocols for AD. "
[Show abstract][Hide abstract] ABSTRACT: Poor adherence to maintenance treatment for atopic dermatitis and anxiety about using topical steroids are common features seen among children with atopic dermatitis and their mothers. No systematic study exploring factors associated with adherence to treatment advice on atopic dermatitis has been carried out to date. This study seeks to generate hypotheses regarding the relationship between a range of psychosocial factors and adherence to treatment advice on atopic dermatitis. An anonymous self-completed questionnaire containing adherence items, psychosocial items, some demographic items, and attitudes to steroid use was given to 258 mothers of atopic dermatitis follow-up patients who attended the National Children's Hospital, Tokyo. Responses from 205 families (80%) with complete data were then analyzed to explore the correlation between each factor and to build a structure equation model. The strongest predictor of adherence to skin-care treatment was a good doctor-patient (mother) relationship, followed by the severity of the disease as perceived by the mother. Surprisingly, the mother's anxiety about using topical steroids had no significant influence on reported use of topical steroids nor on adherence to skin-care treatment. This may have been overcome by the well-established doctor-patient (mother) relationship. Maternal personality, husband's cooperation, and social support were indirectly correlated with adherence via the doctor-patient relationship. Maternal self-efficacy of treatment was strengthened by good doctor-patient (mother) relationship.Keywords: compliance, doctor-patient relations, factor analysis, phobia, steroid
[Show abstract][Hide abstract] ABSTRACT: The influence of a family history of atopy on atopic morbidity, and relationships between diet in infancy and allergic manifestations at the ages of one and five years were prospectively studied in 91 children. A control group consisted of 72 children with no family history of atopy. At the age of one year, atopic manifestations were found in 19% of 163 children, in 23% of those with a family history of atopy and in 14% of those with no such history. Skin problems were more common in children with a family history of atopy (43%) than in the control children (19%). Of the children with a family history of atopy, 23% had prolonged rhinorrhoea during infancy. The corresponding figure in children with no family history of atopy was 10%. Prolonged rhinorrhoea during infancy correlated with parental smoking only in children with a family history of atopy (47% vs. 18%). At the age of five years, atopic disease was found in 17% of 128 children, 24% of those with a family history of atopy and 9% of those with no such history. Atopic eczema was more common in children with a family history of atopy, irrespective of the diet consumed during infancy. Atopic signs were found in about half of all the children with a family history of atopy. If atopy had been present in the family, the child usually exhibited the same manifestation. Onset of atopic manifestations was not prevented or delayed.
[Show abstract][Hide abstract] ABSTRACT: The influence of prolongation of breast feeding and postponement of introduction of solid food during infancy on skin reactivity at the age of five years was studied. At least one positive skin prick test result was observed in 23% of the 70 children with a family history of atopy and in 17% of the 58 children with no such history. Of the 26 skin-test-positive children, 54% exhibited positive reactions to cat dander and 42% to birch pollen. Of the 6 children with asthma, 6 with rhinitis and 17 with eczema, skin reactivity was observed in 66%, 66% and 35%, respectively. Contact with a cat during the first three to four months of life did not correlate with skin test positivity at the age of five years. Skin test positivity to birch pollen was more common in children born in January to February, probably because they were at a vulnerable age in their first birch pollen season in May. No preventive effect by the diet consumed during infancy was seen on subsequent skin test results in relation to common allergens.
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